The authors' affiliations are listed in the Ap-pendix. Address reprint requests to Dr. Chi-mowitz at the Medical University of South Carolina Stroke Program, 19 Hagood Ave., Harborview Office Tower, Suite 501, Charles-ton, SC 29425, or at mchimow@musc.edu.

*The investigators in the Stenting and Aggressive Medical Management for Pre-venting Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) trial are listed in the Supplementary Appendix, available at NEJM.org.

This article (10.1056/NEJMoa1105335) was published on September 7, 2011, at NEJM .org.

Background Atherosclerotic intracranial arterial stenosis is an important cause of stroke that is increasingly being treated with percutaneous transluminal angioplasty and stenting (PTAS) to prevent recurrent stroke. However, PTAS has not been compared with medi-cal management in a randomized trial.

Methods We randomly assigned patients who had a recent transient ischemic attack or stroke attributed to stenosis of 70 to 99% of the diameter of a major intracranial artery to aggressive medical management alone or aggressive medical management plus PTAS with the use of the Wingspan stent system. The primary end point was stroke or death within 30 days after enrollment or after a revascularization procedure for the qualifying lesion during the follow-up period or stroke in the territory of the quali-fying artery beyond 30 days.

Results Enrollment was stopped after 451 patients underwent randomization, because the 30-day rate of stroke or death was 14.7% in the PTAS group (nonfatal stroke, 12.5%; fatal stroke, 2.2%) and 5.8% in the medical-management group (nonfatal stroke, 5.3%; non–stroke-related death, 0.4%) (P = 0.002). Beyond 30 days, stroke in the same ter-ritory occurred in 13 patients in each group. Currently, the mean duration of follow-up, which is ongoing, is 11.9 months. The probability of the occurrence of a primary end-point event over time differed significantly between the two treatment groups (P = 0.009), with 1-year rates of the primary end point of 20.0% in the PTAS group and 12.2% in the medical-management group.

Conclusions In patients with intracranial arterial stenosis, aggressive medical management was superior to PTAS with the use of the Wingspan stent system, both because the risk of early stroke after PTAS was high and because the risk of stroke with aggressive medical therapy alone was lower than expected. (Funded by the National Institute of Neurological Disorders and Stroke and others; SAMMPRIS ClinicalTrials.gov num-ber, NCT00576693.)